Symptom of Endometriosis: Bowel and Bladder Problems

Issues related to bladder or bowel may be some of the most challenging to manage at times, especially when experiencing a loss of control over these organs. Bladder and bowel issues may be the result of an underlying condition, such as irritable bowel syndrome, and can arise as a result of treatment regimen such as radiation to destroy cancer cells in the pelvic area. These problems can also occur naturally with age, or come on suddenly after a major physical event such as a trauma or childbirth.

Common bladder-related issues include:

• Experiencing a burning sensation while urinating
• Having a frequent or urgent need to urinate
• Experiencing an inability to completely empty the bladder when going to the bathroom
• Seeing blood in the urine
• Losing the ability to control the bladder, leading to leakage of urine
• Abdominal pain when the bladder is full^1,2

Common bowel-related issues include:

• Abdominal cramping, pain, or bloating
• Nausea and/or vomiting
• Constipation
• Diarrhea
• Pain or straining while trying to have a bowel movement
• Blood in the stool^3,4

Endometriosis-related bowel or bladder issues

It's important to note that this is not an exhaustive list of all potential bladder or bowel related issues an individual may experience. Additionally, the severity or frequency of these problems may vary greatly from person to person. For some, these may be minor annoyances or virtually undetectable. For others, they may be debilitating. When bowel or bladder symptoms occur in individuals with endometriosis, the severity of their endometriosis does not always correlate to the severity of any bowel or bladder issues they may have. A woman with mild endometriosis may experience several serious bladder or bowel issues, while a woman with very advanced endometriosis may not experience any such symptoms. Common bowel or bladder issues that accompany endometriosis include, but are not limited to:

• Painful urination
• Overactive bladder (urinary frequency or urgency)
• Diarrhea
• Constipation
• Bloating
• Nausea or vomiting
• Straining or pain while defecating^2,4,5

What causes these issues?

Bladder-related issues may be caused by a variety of different factors including underlying conditions such as infections (including urinary tract infections), cystitis (inflammation of the bladder), bladder cancer, or endometriosis. In addition, bladder-related issues may be caused by the natural aging process, pregnancy, or childbirth, as well as a result of another treatment regimen such as radiation or surgery on or around the bladder.^1,2

Bowel-related symptoms have some similar causes, including being the result of another treatment procedure or due to the natural aging process. Several conditions may also contribute to the development of bowel-related problems, including irritable bowel syndrome (IBS), inflammatory bowel diseases such as Crohn's disease or ulcerative colitis, celiac disease, endometriosis, and diverticulitis.^3,5

The relationship between endometriosis and bladder and bowel symptoms is one that is still being actively investigated. Some experts believe that bladder and bowel symptoms may be the result of endometriosis lesions that are growing and breaking down directly on the surface of the bladder or bowel. These lesions may infiltrate deeper than the surface, and may lead to trapped blood within these organs. Additionally, endometriosis-related adhesions (bands of scar tissue) may adhere to the outside of the bowel or bladder, and prevent it from functioning the way it should, leading to pain or straining during urination or defecation. Another common theory is that the constant state of inflammation that endometriosis can cause in certain areas of the pelvis may eventually effect the bladder or bowel and cause issues in these organs.^2,4,5,6

It's also possible that bladder or bowel issues may not be a direct result of endometriosis lesions affecting those organs, but rather, the overlapping of endometriosis with another bowel or bladder-affecting condition such as IBS. Some bladder and bowel-related conditions share similar risk factors with endometriosis, including genetics, family history, inflammation-related issues, and potential immune-system defects. These shared risk factors may contribute to an increase in risk of developing both conditions separately from one another.

How are bladder and bowel issues evaluated?

Evaluating bladder and bowel problems, especially if their underlying source is endometriosis, may be particularly challenging since many similarly presenting conditions have the ability to cause these issues. As an example of this potential difficulty, an individual may go to their general practitioner with a complaint of pain while urinating or defecating. Their primary care doctor may then send them to a gastroenterologist to determine what could be impacting their bowel function, as well as to a urologist to look at their bladder. These specialists may speculate a bowel or bladder-only related condition, and not consider endometriosis. It may take a long time for other non-endometriosis causes to be ruled out, which may not even occur until the individual starts experiencing other symptoms that might bring them to their OB-GYN, who then might suspect endometriosis.⁴

Conversely, if an individual is having pelvic pain and difficulty while defecating, they may be sent directly to an OB-GYN, but have a gastrointestinal-related condition rather than endometriosis. Since all of these conditions are very similar and are sometimes treated or investigated in different ways, it may take some time for all of the pieces to come together.

Overall, however, these providers will often take information on your personal medical history, any past medical procedures, if you have family history of a condition like endometriosis or one of the other potential symptom-causing conditions, or if you're having any other problems. From there, your provider may recommend blood work, imaging exams, or even laparoscopic surgery. A laparoscopy is a minimally invasive surgical procedure that allows a physician to get a direct view of what's going on inside the pelvis. A laparoscopy is the only official way to receive a definitive diagnosis of endometriosis.^2,4,5

Treatment and management

The treatment and management of bladder and bowel problems depends on the issue experienced. For example, if an individual is having difficulty or pain with urination that's caused by an underling urinary tract infection, they may be given antibiotics to treat the infection. If an individual has IBS and has persistent diarrhea, their doctor may recommend that they take antidiarrheal medications. If an individual's bladder or bowel issues are thought to be a result of their endometriosis, common endometriosis treatment options may be pursued, such as hormonal birth control methods. If their symptoms are thought to be a result of an endometriosis lesion, or multiple lesions, growing directly on the bladder or bowel, surgical removal of these lesions may be necessary for symptom relief.^1,4,5,7

In addition to some of these treatment options, lifestyle changes including changes in diet or exercise regimen, stress reduction techniques such as meditation or yoga, carrying or wearing absorbent pads, and alternative pain-relief options such as acupuncture may be pursued in order to help manage bowel or bladder-related issues.